What dose would you consider for a patient who received 59.4 Gy 18 years ago for a glioma of the right frontal lobe who is now S/P gross total resection for a high-grade glioma in the same area?

Given that the patient was treated 18 years ago and has undergone GTR, I would be more inclined to treat to the full dose using standard fractionation; 54-59.4 Gy in 30-33 fractions (depending on molecular features). I would treat with concurrent bevacizumab in addition to any other systemic therapy...

Based on the monkey spinal cord re-irradiation experiment done at M.D. Anderson many years ago, we learned that spinal cord repair after radiation was almost complete after 3 years. If we extrapolate the data to brain tissues and structures, we could now deliver the usual 59.4 or 60 Gy to the same a...